Leg Bags: fitting and securing.

For those patients requiring leg bags, the correct method of securing and managing the catheter and its drainage device should be considered essential nursing care.

Our aim is to prevent accidental dis-lodgement, trauma, pressure injury, urinary retention, infection and the embarrassment to the patient of urine leaking around the catheter.

Catheter security.

There is little evidence to support any single best method of securing a catheter at this time.
Several commercial devices are available (such as the StatLock) as well as the various nurse-spun taping and tying solutions.

Failure to secure (or to properly secure) a catheter may result in dislodgment. It also leads to an increased incidence in catheter-associated urinary tract infections thought to be due to increased, repeated motion of the contaminated catheter against tissue surfaces.

Care should be taken with using adhesive tape or devices on patients with excoriated, damaged or sensitive skin. The use of non-sterile adhesive tapes should be discouraged. It can cause localised skin reactions an is often difficult to remove. There is some evidence that the solvent present in the adhesive may damage catheter material.

Drainage systems.

Urimeters: indicated when precise monitoring of urine output is indicated.

Catheter bags provide larger capacity continuous drainage.

Leg bags: provide a more convenient and discrete option for urine drainage.

Leg bag security.

Leg bags should be attached to the calf or thigh using both the provided straps (or a catheter sleeve) to prevent the bag flipping over and kinking the tubing.

The straps should be secured by passing them behind the leg bag so they will not squeeze over the top decreasing the bags capacity.
If the bag is not properly secured its weight may inflict a damaging traction on the urethral opening and/or the bladder sphincter.

Attaching the leg bag straps too tight or too loosely may result in skin damage. Tight leg bag straps may restrict venous and lymphatic flow increasing the risk of deep vein thrombosis (DVT). Caution should be exercised when considering using leg bag straps on patient with poor circulation, phlebitis or peripheral vascular disease.

An alternative to straps is the leg bag sleeve. This produces a more even distribution of weight around the leg.

Leg bag management.

There is a wide range of leg bag products available as well as a selection of capacities to meet individual requirements (e.g. 350, 500, 750ml).

When choosing a leg bag option or educating your patient there are a number of things to think about. Particularly if this person is about to be discharged into the community:

Optimum positioning for this person. Taking into consideration the patients activities and preference the bag may be secured on the thigh or calf. Sterile scissors may be used to alter the tubing length.

Is the patient able to operate the drainage tap?

Is the patient able to connect and position the night drainage bag?

Is the bag comfortable?

Is the bag discreet?

The catheter and tubing should be regularly checked for kinking which again may lead to leakage around the catheter.

Leg bags should be changed before they become overfull. A full bag places significant weight on the securing system. This may result in pressure injury beneath the straps or pressure on the pelvic floor or urethra. It also results in pain and irritation.

The drainage system must be properly connected and positioned at all times.
If the leg bag or drainage bag is positioned higher than the level of the bladder, urine will not effectively drain. This may result in leakage around the catheter at the urethra risking skin breakdown and embarrassment
This is of particular note to patients with a leg bag who may lay down for an afternoon nap or sit in a chair with their legs elevated.
As a rough guide, the bag should be emptied when it is half to two-thirds full or frequently enough to prevent it becoming too heavy for that particular individuals situation.

At night, a night drainage bag (typically a larger 2 litre capacity bag) can be connected to the system. This can be done by the patient and need not be sterile. This night bag should be regularly cleaned with warm soapy water and rinsed.

When in use it should be supported off the floor to promote drainage and lower the risk of infection.
Leg bags must be replaced every 7 days or as per the manufacturers recommendations.

References:

Fisher J. The importance of effective catheter securement. British Journal Of Nursing [serial on the Internet]. (2010, Oct 15); 19S14–8. Available from: CINAHL Plus with Full Text.

Mangnall J. Selecting the right urinary leg bag drainage system for patient needs. British Journal Of Nursing [serial on the Internet]. (2011, July 12); 20(13): 797–802. Available from: CINAHL Complete.